Vision Problem Symptom Checklist

• Signs of a Vision Problem
  Frequency
• Blur when looking up close
  Never Sometimes Often
• Double vision
  Never Sometimes Often
• Headaches working up close
  Never Sometimes Often
• Falls asleep when reading
  Never Sometimes Often
• Poor reading comprehension
  Never Sometimes Often
• Skips/repeats words/lines when reading
  Never Sometimes Often
• Loses place reading or copying
  Never Sometimes Often
• Uses finger as a pointer
  Never Sometimes Often
• Tilts head/closes one eye when reading
  Never Sometimes Often
• Avoids near work/reading
  Never Sometimes Often
• Print appears to move when reading
  Never Sometimes Often
• Labeled “lazy”, “slow learner”, “AD(H)D” or “behavior problem”
  Never Sometimes Often
• Misaligns digits or columns of numbers
  Never Sometimes Often
• Dizziness/nausea with near work
  Never Sometimes Often
• Excessive blinking/rubbing eyes
  Never Sometimes Often
• Poor/inconsistent in sports
  Never Sometimes Often
• Holds reading material too close
  Never Sometimes Often
• Trouble keeping attention on reading
  Never Sometimes Often
• Difficulty completing assignments on time
  Never Sometimes Often
• Avoids sports or games
  Never Sometimes Often
• Poor handwriting
  Never Sometimes Often
• Difficulty copying from chalkboard
  Never Sometimes Often
• Clumsy/knocks things over
  Never Sometimes Often
• Car/motion sickness
  Never Sometimes Often
• Sees worse at the end of the day
  Never Sometimes Often
• Homework takes forever
  Never Sometimes Often